Integrated Health Care for Foster Youth

“What we set out to do was establish a system that would, in fact, cater to the needs of foster children in one place,” Jacquelyn McMillon says, “and that children did not have to go all over the city of Houston to get the most basic of care.”

In 2015, the Texas Department of Family and Protective Services (DFPS) found that nearly 28,000 children across the state were in the custody of Child Protective Services (CPS). Of these tens of thousands of youths, an estimated 40 to 60 percent have behavioral health problems.

The complex emotional and behavioral challenges faced by foster youth demand an exceptional amount of individual attention and care — a demand that, for many, is left unsatisfied.

When a child falls through the cracks of the Texas foster care system, a lack of services isn’t always to blame. Gaps in accessibility play a major role in who receives treatment and who doesn’t, making it difficult for services to find their way to those who need them most. The system’s haphazard structure also makes it prone to breakdowns in communication and organization, resulting in overburdened caseworkers and even neglected allegations of child abuse.

Joining host Ike Evans to speak about the program’s successes and limitations is Jacquelyn McMillon, Children’s Services Administrator at the clinic. Kate Murphy, a policy associate at Texans Care for Children, follows up McMillon’s insights with a special report on the 85th legislative session’s impact on child welfare at large.

Coming Together and Going Deeper

HCPS has provided foster children from infancy to age 17 with medical services since 1972. Behavioral health services, however, constitute relatively new territory for the network.

In order to navigate and eventually chart that territory, it became clear that consistent dialogue between stakeholders would be essential. A “collaborative committee” of HCPS alumni, caseworkers, administrators, and even actors outside the organization convened in order to establish lines of communication.

“It’s crucial to have all of the different entities at the table that will impact the life of a child who is involved in CPS,” McMillon says. Such is the very meaning of integration in health care — collecting “under one umbrella” several services that don’t operate as effectively in isolation.

The different entities who help make integrated health care a viable model also help combat one of the Texas foster care system’s biggest problems: its lack of cohesion.

“People are talking about children in CPS custody, and some of the abuse and neglect that occurs to children,” McMillon says, “and yet all the systems … are not talking to each other, are not talking about what’s in the best interest of these children.”

Fractured lines of communication can result in a mismatch between a child’s needs and the services they’re offered. But limiting programmatic focus to providers alone would also be a mistake.

Efforts must be made to deepen our understanding of how we examine, diagnose, and treat individual foster children. “A lot of looking at foster children is about looking at the context of their behavior in the here and now,” McMillon says.

Child Welfare at the Capitol

For many Texans, the here and now will be impacted in no small part by the 85th Texas legislative session — and those holding out for child welfare reform are no exception. In fact, surprising though it may seem, they actually have much to be hopeful for.

Prevention services, or approaches geared toward keeping children safely at home with families and out of the foster care system entirely, were awarded with a “huge” investment during the regular session, in the words of Kate Murphy of Texans Care for Children.

“Along with that boost in funding came some strategic planning for how to expand those services and really get them to the people who need [them] the most,” Murphy says.

Measures for workforce expansion were also approved, creating hundreds of new caseworker positions and an array of services for caseworkers themselves, such as secondary trauma support and caseload management tools.

This progress notwithstanding, the circulation of myths about CPS threatens to undermine some of this forward momentum. According to Murphy, some at the Capitol have taken to framing CPS as an “enemy” of child welfare — a distortion that could unnecessarily hinder future reform efforts.

“It’s a very troubling simplification that we’re removing kids at an alarming rate,” Murphy says, “particularly when Texas has one of the lowest rates of removal in the entire country.”

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